Psoriasis is a chronic systemic multifactorial disease with genetic predisposition that affects the skin and joints. Patients often complain of a pinkish-red rash with silvery-white scales. The rash is accompanied by itching, pain and peeling. When the joints are damaged, their mobility is limited, which can cause disability in the patient.
Causes of psoriasis
The cause of psoriasis remains unknown. There are only theories of origin:
- neurogenic (the appearance of rashes after stress, burns, mental trauma);
- endocrine (especially during the perimenopausal period);
- metabolic (disorder of fat metabolism);
- infectious;
- viral (psoriatic antigens are isolated from healthy people, but with a high probability of developing psoriasis in the future, while psoriasis is a non-contagious disease);
- genetic.
Psoriasis can be traced across an entire generation of people with the same risk factors. But the type of inheritance is assumed to be multifactorial. If one parent is sick, the child has a 25% chance of getting sick. If both parents are sick – 60-75%.
Viral and genetic theories continue to be the leaders.
Factors that contribute to exacerbations:
- infectious and parasitic diseases, including transport (HIV, tonsillitis, carious teeth, hepatitis);
- stress;
- obesity;
- perimenopausal period;
- medications (interferons, beta-adrenergic receptor antagonists, ACE antagonists, NSAIDs);
- bad habits (alcohol, smoking, household chemicals);
- skin lesions; dryness, leading to increased skin trauma.
Clinical classification
There is no single classification. One of them:
- vulgar (ordinary);
- exudative;
- psoriatic erythroderma;
- arthropathic;
- psoriasis of palms and soles;
- pustular psoriasis.
Flow characteristics:
- They get sick at any age, cases of psoriasis in children are not uncommon;
- men and women get sick equally;
- prevalence worldwide;
- There is summer, winter and mixed seasonality of exacerbations.
Symptoms of psoriasis
The disease itself is characterized by a violation of skin keratinization with the production of insufficiently mature keratinocytes. Pinkish-red rashes appear, covered with silvery-white scales.
A triad of symptoms is characteristic, thanks to which a diagnosis can be made:
- stearin stain symptom: when scratched, the number of scales increases;
- the psoriatic film phenomenon: when all the scales are scraped off, a smooth, shiny red surface appears;
- a symptom of spot bleeding: when the film is scratched, drops of blood appear. This is due to the uneven elongation of the papillae in the dermis, the expansion of the capillaries and their swelling.
Signs of psoriasis
- Psoriasis on the body can start with a spot and coalesce into large areas of damage.
- Psoriasis on the hands is most often located on the extensor surfaces.
- Psoriasis on the face: the rash usually appears behind the ears, on the forehead. It is an independent factor to improve treatment.
- Psoriasis on the scalp is an isolated form, it does not affect the hair, the elements of the rash are located along the edge of the hair, "psoriatic crown".
- Nail psoriasis - leads to characteristic changes, point depressions, the nail looks like a thimble. It may also thicken, become opaque, or form yellow spots under the nail.
- Psoriatic arthritis: Affects the peripheral joints with or without pain, often with inflammation at the attachment of the ligaments to the bone, the ligaments themselves, and the fingers.
Characteristics of psoriasis in children.
Characterized by the presence of one or several elements up to 1 cm, they rise above the surface of the skin. Itching in children is more pronounced than in adults. After scratching, the spot bleeds and wounds form. In children, psoriasis is usually located in the perineal area as a large red spot. In adolescents, spots appear on the palms and soles of the feet.
There are three stages of psoriasis:
- Progressive - the elements of the rash increase and are uniformly white, with a narrow red border along the edge;
- Stationary - the growth of the spot stops, a strip of paler skin appears along the edge 2-5 mm wide;
- Regressive stage: the scales gradually fall off, the spot decreases and disappears. A depigmented spot remains at the site of the rash.
Diagnosis of psoriasis
Most often, patients turn to a general practitioner, a dermatovenerologist, or a rheumatologist (for psoriatic arthritis). The doctor collects complaints (presence of skin rashes, itching, pain, swelling and tenderness in the joints), anamnesis (seasonality of exacerbations and their frequency, genetic predisposition, effectiveness of previous treatment, concomitant diseases). Upon examination, changes are found in the skin and joints.
Laboratory tests are performed:
- general blood test (including leukocyte count, ESR, platelets);
- general urine analysis;
- biochemical analyzes (ALT, AST, urea, uric acid, cholesterol, triglycerides, bilirubin, glucose, total proteins, CRP, rheumatoid factor);
- in difficult situations, a skin biopsy is performed with additional histological examination (acanthosis, parakeratosis, pronounced spongiosis and accumulation of leukocytes in the form of heaps of 4-6 or more elements);
- before prescribing biological treatment, an examination for HIV, viral hepatitis B and C and tuberculosis is carried out;
- x-ray of the affected joints;
- CT and MRI for axial lesions;
- ECG.
If necessary, consultations are carried out with an infectious disease specialist, a phthisiatrician, an orthopedic traumatologist, a surgeon and other specialists.
When diagnosing psoriasis, it is worth excluding diseases such as seborrheic dermatitis, lichen planus, parapsoriasis, zhiber rosea and papular syphilid.
The severity of psoriasis is determined by BSA (body surface area, the area of skin affected by psoriasis), PASI (psoriasis severity and area index, psoriasis prevalence and severity index), DLQI (psoriasis quality index of life in dermatology, dermatology quality of life index).
To diagnose psoriatic arthritis, the PEST (Psoriasis Epidemiology Screening Tool) and CASPAR (Classification Criteria for Psoriatic Arthritis) criteria are used.
Psoriasis treatment
The treatment is complex and aims to eliminate inflammation, normalize the proliferation and differentiation of keratinocytes.
Local therapy:
- ointments and creams with vitamin D3 and its analogues;
- calcineurin inhibitors;
- glucocorticoids for local use;
- phototherapy.
Systemic therapy:
- PUVA therapy;
- cytostatics;
- immunosuppressants;
- biological medications.
For use in psoriatic arthritis:
- non-steroidal anti-inflammatory drugs;
- disease modifying drugs;
- intra-articular injections of glucocorticoids;
- biological medications.
In chronic cases, it is recommended to use psoriasis ointments, in case of exacerbations, psoriasis creams are used.
When applying an ointment or cream, do not rub it into the skin or apply a bandage. This can increase the penetration of the drug into the skin and cause side effects.
It is not recommended to use hormonal ointments for more than 4 weeks. Incorrect dosage of medications can be ineffective or cause side effects. The expected effect of the treatment occurs after 1 to 2 weeks of use.
There are several ways to use psoriasis creams and ointments containing glucocorticoids:
- continuous mode;
- tandem therapy mode;
- descending therapy regimen;
- step by step application mode.
It is worth noting that the treatment of mild and moderate forms of psoriasis is carried out on an outpatient basis, using ointments and creams directly on the affected area. For more severe forms, treatment is carried out in hospitals using phototherapy, systemic therapy and biological drugs.
The course of the disease is considered moderate and systemic treatment can be started in the following cases:
- areas of the skin of aesthetic importance are affected;
- large areas of the head are affected;
- the external genitals are affected;
- palms and soles are affected;
- at least 2 nails are affected;
- There are individual elements that cannot be treated locally.
Systemic therapy is carried out only in a hospital, under the strict supervision of doctors, since systemic treatment is associated with a wide range of side effects, which can be reduced by selecting individual treatment.
General recommendations for patients with psoriasis:
- minimize skin trauma and dryness;
- after applying psoriasis creams and ointments to your hands, wear gloves to prevent the medicine from getting into your eyes;
- use sunscreens with a protection factor 30;
- avoid stressful situations, consult a psychologist if necessary;
- Control your weight, eat rationally.
Diet for psoriasis
Recommended:
- alkaline drink 1200-1600 ml per day;
- use of lecithin;
- vegetables and fruits;
- porridge;
- lean meats and fish;
- dairy products.
Not recommended:
- citrus;
- bread made with top quality flour;
- fatty fish and meat;
- high-fat dairy products;
- coffee – no more than 3 cups per day;
- yeast products;
- alcohol, sweet, pickled, smoked, spicy.